How to Get Started on HYH

Right now, you might be feeling a little overwhelmed, and that is totally normal. I’ve seen some dramatic comments about this diet in my online support groups—but I can assure you that you will not starve, and you might even find new foods to enjoy. If you’re reading this book, I know you’re committed to improving your health and making the effort to feel better. Let’s start with a few tips that will set you up for success.

• Make sure there’s no chance you are in a rebound cycle. As discussed earlier, simple analgesics (NSAIDs like Aleve and Tylenol) can cause rebound if taken more than fifteen days a month. Combination pain relievers like Fioricet or Excedrin, ergotamines and triptans, and opioids can all lead to rebound if taken more than ten times a month for three consecutive months. Butalbital-containing Fioricet is most likely to lead to rebound and typically occurs if taken more than five times per month. If you are in rebound, nothing recommended in this book will help you. You will need to work with a headache specialist or a neurologist who is familiar with rebound to break the cycle before embarking on a diet-related symptom reduction plan.
• Get your family on board. This might require some extra cooking on your part, but I promise your family will love the majority of recipes in this book and will barely notice they are missing anything. If your family knows this diet has the potential to make you feel better and enjoy more time with them, they will support you wholeheartedly.
• To see results, you need to fully commit. There are some people who swear they don’t have food triggers. While that is true for a few, I find that if I do a little digging, they eventually admit they couldn’t live without coffee, or only tried the diet for a month and didn’t notice any change. Or they never fully eliminated everything all at once. That’s not a solid effort, and you cannot expect great results if you don’t go all in. For those who have given the diet a real chance for over four to six months without any change, it is recommended to eliminate additional potential triggers like tomatoes, mushrooms, apples, and eggs. Another option is to look into an alternative diet, like the Ketogenic diet, or focus on what might not be working with the other parts of the treatment. Perhaps trying or adding another medication, changing supplement brands, trying mindfulness or adding Cognitive Behavioral Therapy to the arsenal could be beneficial.
• Do a pantry cleanout. Get rid of all the sauces and condiments that have hidden MSG or trigger ingredients. If you can donate them to a migraine-free neighbor or friend—or a food bank—that’s even better.
• Plan your meals in advance. Pick three to four recipes that interest you and make a grocery list. Because of all the sensory stimulation in the store, grocery shopping used to be a horrible trigger for me, so I would go either first thing in the morning or later in the evening, wear a hat and FL-41 lenses (specially tinted glasses for migraine and light sensitivity), and even use earplugs or listen to music. The first trip to the store when starting this diet should be during a time when you won’t feel hurried or rushed. That way, you can review all the labels and see what you are working with. There are now grocery pickup and delivery services that can make life a lot easier on bad days.

• Using your smartphone, take a picture of the Sources of MSG and Foods to Embrace lists on pages 17 and 18–19. Bring the list with you while grocery shopping so you know exactly what to look for. With time, spotting hidden MSG will get much easier and you’ll be able to find the favorite migraine-friendly options quickly.
• Remember: Radical blood sugar fluctuations can trigger a migraine attack. With a diet that allows ice cream, sugar, and carbohydrates, it can be easy to get carried away and replace healthy staples with something easy to eat like chips or cookies. Eating regular meals can help control this as well as having healthy snacks readily available. If you’re going to have something sweet, it can help to also make sure you’re consuming something with protein along with it. For example, fruit smoothies can cause a spike in blood sugar. To balance this, you can add extra fat and fiber like sunflower seed butter and chia seeds. Hemp seeds are a good addition for protein as well. Balancing carbohydrates with protein and fat will be a recipe for success.
• Always have migraine-compliant snacks and quick meals on hand. Some good things to keep stocked in the pantry and fridge are apples and pears, sunflower seed butter, chopped vegetables, pasta, crackers, and fresh cheese.
• Know that you will mess up. And that’s okay, especially in the first month, because this diet is tough to get accurate 100 percent of the time. I always say the first month doesn’t really count because you’re still learning how to shop and changing your habits. Just make sure if you fall off track, you immediately right yourself and try again. One bad day won’t ruin the progress, but a collection of them will.
• Don’t be discouraged if you don’t feel better immediately. I think this is the most important thing to remember. It’s easy to be frustrated when you’re working so hard at something and not seeing results. The body takes time to change, especially with natural treatments. Heal Your Headache says to give the diet two months to start to work, then another two months to see results, but I have many friends who didn’t notice results for six to nine months. Let go of that set timeline you have in your head. The goal should be to have a reduction in migraine days that you are comfortable with and maintain for a while before you reintroduce foods. This diet isn’t a forever thing, it’s meant to help you find your food triggers and lower your overall migraine threshold. The more my migraine symptoms improved over time, the more foods I found I could tolerate.
• If you go on vacation, try to stick with the diet without being super intense about it. Even Dr. Buchholz admits you can get away with things that you normally wouldn’t, like perhaps red wine and chocolate on a trip to France. I found this to be true. When we’re away from the responsibilities of home or work, often our trigger-load is low enough to accommodate a few cheat meals. Just make sure not to get too carried away. I can’t really help you if you’re six mai tai’s in and doing the hula down the beach.
• Know that eating out is still possible! Check restaurant menus online ahead of time and ask the server questions. Most of the time you can find grilled meat, sautéed vegetables, a burger, or a salad that you can tailor to fit HYH. With salads, ask for olive oil and pepper, or even bring a small container of homemade dressing. Plain fast food burgers like Five Guys and McDonald’s can be safe in a pinch. (Shocking, I know, but they don’t add anything to their beef.) Chipotle is another fairly safe option. Be careful with condiments.

REINTRODUCING FOODS

It’s important to note that an elimination diet isn’t forever. Let’s say after three to four months or longer, you’re finally in a comfortable place where you feel you have control over the migraine attacks. My personal journey had me noticing a slight difference between four to six months, but the longer I kept with it, even loosely at that point, the better I felt. Either way, you will eventually get to a point where you are able to reintroduce foods to see what might trigger you. The best way to approach this is to keep a diary or notes of what food you plan to introduce that week. It’s always best to start with the foods you miss the most or that are most inconvenient to not have. For me, this was avocado and lemon juice.

It’s helpful to start with a modest amount of the potential trigger food the first day and then work up to more. For instance, on the first day maybe you start with a slice of avocado. If you feel great, then add a little bit more the next day—perhaps a generous topping on a salad. Then if you still feel great, try a little bit of semi-safe guacamole (avocado, cilantro, and a splash of white vinegar to keep triggers separated).

Occasionally, food triggers can present themselves up to two days later, but with such a long time it’s easily confused with other factors like barometric changes, stress, or hormones. The most commonly reported period to react to a food trigger is within a few hours. What typically happens when a migraine takes a couple of days to trigger is that a person is testing multiple days in a row and, combined with other factors, the trigger load keeps stacking on itself until it overflows. This was the case for me when I tried avocado in the beginning. I found my immediate triggers were yogurt and walnuts, but avocado was so unclear. Sometimes I would get a spike in dizziness and other times I was totally fine. I decided to eliminate avocado for a while longer since it seemed to be a low trigger for me, bothering me more on days when my other triggers (weather, stress, etc.) were high. After a few months and even more improvement with my vestibular migraine, I was eventually able to reintroduce avocado successfully.

Three years later, I’m able to eat most foods that are on the “not allowed” list. Yogurt, caffeine, and most nuts continue to be triggers that I test every so often to confirm. Even though I don’t always follow a migraine diet 24/7 now, I am still mindful on days when I’m stressed, traveling, or driving a long way, and my trigger threshold is low. In these cases, it helps me to be a little stricter than I otherwise would be. Even just cooking my own foods versus eating out or picking up fast food can go a long way.

REINTRODUCTION TIPS

• Start with the foods you miss the most.
• Try one new food a week, testing the ingredient for three to five days in a row.
• If you feel symptoms, consider the possibility that it might be due to other factors such as weather, hormonal changes, and stress levels, which can raise or lower the threshold for food triggers.
• If a food trigger seems unclear, take a break from the ingredient for a week and try again.
• If you think symptoms have been triggered by that ingredient, you can put it on the “no” list for now. Consider testing it again at some time in the future, because trigger sensitivity can change with time.

TIPS FOR READING LABELS

Even now that I’ve been able to incorporate many foods back into my diet, I still check every label before making a purchase. It’s become a habit that I will be forever thankful that I learned. You see, I thought I ate healthy before, but I rarely checked ingredient lists on things like raw chicken, crackers, cream, and butter. Who would ever think there could be additives in those?

• Check for Hidden MSG. Take a picture of the list from this book to easily reference on the phone when you shop. MSG is present even in foods that are marketed as natural.
• Get on the “short list.” The shorter the list of ingredients, the better. If you can’t pronounce half of them, there are usually better options. Sometimes you just have to dig a little bit.
• Sodium is important. Although some migraine sufferers can benefit from sodium, others who struggle with a related disorder, Meniere’s disease, must limit it. If you find that one serving of a food contains a hefty amount of sodium for the day (around 30 to 40 percent), it’s best to skip that item. Manufacturers can sometimes try to make up for lack of freshness by adding a ton of sodium. This is why I recommend seasoning a lot of these recipes to taste.
• Position matters. Ingredients are listed by weight on labels, so what’s at the beginning of the list will be more impactful on the symptoms than what’s listed toward the end. If a trigger ingredient is near the end of the list, it most likely won’t be as much of an issue. This is why mayonnaise with lemon juice as one of the last ingredients can be more tolerated than if lemon juice were at the top of the list.
• Google is your friend. If you can’t figure out the name of an ingredient, just look it up. Often you can tell if it’s linked to MSG in some way or if it’s a fermented item just by doing minimal research.
• Check the spices. You’ll want to make sure there’s nothing added, even if the label doesn’t state it. For example, some chili powders can add in triggers like cocoa to the mix. Same with curry powders or taco spice mixes. Be careful with ingredients that contain just “spices.”
• Organic is great, but not always necessary. The only plus is that organic items typically have fewer additives (but not always). My standard is to choose organic for most meat, eggs, and milk products, but to let it slide on certain vegetables and fruits. Occasionally I will follow the “Dirty Dozen” List, which is put together by the Environmental Working Group (EWG), a nonprofit that ranks fruits and vegetables based on pesticide contamination. If you can buy local, that’s even better. Just work with what you can afford.